HSE hiring pause on physician associates remains in place

A HSE pause on the hiring of physician associates, who assist doctors and surgeons, will remain in place while the recommendations of an independent review into the role are being implemented.

The review, published today, sets out the purpose of the role, which was first piloted in Ireland in 2015, and recommends a graduated scope of practice.

It found that feedback from clinical teams, where the role was already in place, was "positive", but it also found that the role had "evolved without a clear, nationally agreed definition of its purpose, scope of practice, or governance framework", and it made recommendations on each.

Physician associates, who are sometimes called physician assistants or PAs, assist doctors and surgeons in public and private hospitals, as well as in GP clinics around the country.

Following the pilot programme in Beaumont Hospital in 2015, the Royal College of Surgeons in Ireland (RSCI) began the first and only Masters in Physician Associate Studies in 2016, and since then 112 graduates have completed the full-time two-year programme.

The RSCI has consistently said that PAs "are not replacements for doctors" but they are trained and work to "increase the productivity of the medical or surgical team as directed by their consultant supervisor".

According to the HSE, there are currently 30 PAs working in HSE-funded hospitals and services in Ireland.

Around 30 are also currently working in private hospitals and GP practices.

In July 2024, the HSE paused PA recruitment, despite agreeing to fund the studies of RCSI PA Masters students from January that year, in return for a commitment to work in HSE-funded services for a period of years.

In 2025, the HSE's National Service Plan committed to appointing an "independent expert" to "carry out a comprehensive assessment" of the role "and make recommendations for standardisation, scope of practice, and appropriate deployment in Ireland."

The review was led by Leo Kearns, a former CEO of the Royal College of Physicians of Ireland and of the Irish Medical Council, who was also previously National Lead for Transformation and Change for the HSE.

Beginning in May of last year, the review carried out surveys and focus groups, and examined case studies and engaged with various stakeholders.

Its report was submitted to the Department of Health in December and is being published today.

Presence of PAs 'contributes to safer care'

It found that where PAs were employed in publicly funded health services they were "consistently described as providing valuable continuity, coordination and organisational support within consultant-led teams, particularly in environments characterised by high NCHD rotation, fragmented pathways, and operational complexity."

The report went on to say that "their permanent presence contributes to safer care through consistent documentation, reliable follow-up processes, and support for multidisciplinary communication, while freeing NCHDs to focus on training and clinical decision-making."

However, it found that the absence of an agreed definition of a PAs purpose, a scope of practice and a governance framework had "resulted in considerable variability across sites, uncertainty for clinicians and PAs, and avoidable risk."

"In the absence of such clarity, the future development or expansion of the PA role cannot be safely supported," the report added.

However, it makes a number of recommendations to address this.

It concluded that the "primary purpose" for the PA role in the Irish healthcare system was "to assist the medical team in its provision of care to patients, by supporting the organisation, coordination and continuity of medical care, and by carrying out defined clinical tasks and procedures under a medical practitioner's supervision or oversight."

"A PA is not a substitute for a doctor and must not be employed, rostered or deployed as such" the report said, but it also said that this was being emphasised "not because PAs themselves are in any way unclear about the distinction, but because there has been some general confusion about this distinction, mainly in other jurisdictions."

Report recommends 'exclusions' on activities PA can undertake

The report recommends a Core Scope of Practice for new PAs which includes a required "period of clinical induction".

There is also provision for an Extended Scope of Practice, including "higher-risk activities that require more extensive local verification and training."

The report also recommends an 'exclusions' list of activities that "must not be delegated to PAs" due to what it said were "legal restrictions, required medical expertise or patient safety considerations."

These include prescribing medications, ordering ionising radiation, diagnosis and discharging patients.

It also recommended that "all activities that involve the PA in direct patient or family interaction must be directly supervised until competence has been assessed and signed-off".

In terms of PA governance framework, it recommends five levels, ranging from day-to-day up to national.

It also recommends initial PA deployment "primarily within the medical and surgical functions of acute hospitals" where it said "the role has demonstrated value and governance structures can be consistently applied."

But said that "future expansion may occur following national approval and evidence of sustained governance effectiveness".

In February, Minister for Health Jennifer Carroll McNeill said she had received the Independent Review Report and had asked the HSE to prepare a plan to implement its recommendations.

Last month, the Seanad heard that the Minister had received the HSE's plan and that it was moving onto the implementation phase.

Upon releasing the report today, the HSE issued a statement saying that it was "actively working with clinical leaders, professional bodies, and stakeholders to implement the recommendations of the review" but it did not give a time frame.

The statement also said that "the HSE wishes to acknowledge the professionalism, dedication, and valuable contribution PAs currently working within the system provide to patient care."

In relation to the current pause in the recruitment of PAs to HSE-funded hospitals and services, it said it was engaging with the Department of Health "to develop an appropriate mechanism to facilitate the recruitment of PAs into the services" but again, did not provide any time frame.

ISPA questions lack of time-frame on changes and resuming recruitment

The Irish Society of Physician Associates (ISPA) has welcomed the publication of the report and its positive findings in relation to the impact working PAs were having.

ISPA President Helen Farrell also welcomed some of its recommendations.

"It has highlighted the need for a national (governance) framework and a scope of practice for PAs, which is good news to us because we want that as well, it protects us, it protects patients, it protects all the other staff in the hospitals, so we're very much on board with that recommendation," Ms Farrell said.

However, she said she was concerned that no timeframe has been provided as to when these changes "might be commenced" and the HSE pause on recruiting PAs "might be lifted."

"That's a big concern obviously for members who are unemployed and ready to work," Ms Farrell added.

Ms Farrell said they also wanted further discussions on some of the tasks included in the report's suggested 'exclusions' list.

"We understand that legally, without regulation, the ordering of ionised radiation and medication prescribing is not on the board at the moment, and we completely understand that," Ms Farrell said.

However, she said that ISPA would like to discuss the inclusion of "discharging patients or diagnosing."

The report said that in relation to such tasks, "the responsibility of the doctor cannot be delegated to a PA" but noted that "participation (by a PA) may still occur in a supportive, information-gathering capacity under supervision."